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PERMITTEE NAME/ADDRESS rtndudr Fa~ilitr \'ame/Guariun ijDrj/erretl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />NAME DISCHARGE MONITORING REPORT (D R) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br />r::1 ?'i Lt F' , . <br />Form Approved. <br />OMB No. 2040-0004• <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE - _ ~~ ~~i <br />I <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT ~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cerlih ender penwur ++rlaw mad mn d«wmem amf au auachmentc wrrr _ TELEPHONE DATE <br />prcparcd urwlvr rcq direclinn or wrpvni.ion in accordance with a .pNem de.igntd , <br />+ <br />r <br />to Q wire Ihar qunlifitd per.onnd prnprrl) Ralher amt e~aluatr liw~ inforrnatiow t <br />auhmiued. Rawl ua m) inywiry a( the perw-.n ..r prrw+rt. wh+. nwna¢e the yacm. .~ ~ <br />wr thou penon~ direcll~ r~aw+n.ible for {;mherin4lhe information, the inL.rmatLm 1 - i <br />~•~ i <br />whmiUed i., t.. the twnr .d m. Awow1edxr and bdirl, tr~w~• uccurmr, and compktr' $IGIIIATURE OF PRINCIPAL EXECUTIVE ~ <br /> i am a»arr thnt Iherr are .ignificant Ix•nallie. G+r whmittinK falu informalttn, <br />i OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />TYPED OR PRINTED n~. +iulaGone, <br />imludiw~; thr pos.ihdity .d tier and imyric.mnxnt for knnw D <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />~! ?, •~,-Pi~'lr? '1FR1'.'r~T?C~hJS ~~' "TCiXIC I-I'.." r?~'1' I._(1WE~:T <br />tr-~r- tn-`rnir• tF'=:. ~'iif)F= .r~+ AT fAS:H (..t-4FlUlti1 1!.)le I_~:;;! f~I°~_ I~' <br />EPA Form 3320-1 ~Aev .. ~~, F'e~~ou~ ed!io^_ n y ;,_ ,_ _, i~hi~ i~ a !-14U"t (r+rtl~ <br />